Abstract: Background:
Controlled clinical trials of influenza transmission from artificially inoculated individuals have the potential to test hypotheses about modes of transmission. Here we compared the influenza virus content of fine (<5μm) and coarse (≥5μm) aerosol particles in expired breath from persons with experimental infection (EI) and natural community acquired infection (CAI) to determine whether experimental human infection can serve as an appropriate model for simulating influenza transmission.
Methods:
We recruited CAI cases from the UMD campus and studied EI (by nasal inoculation with GMP A/Wisconsin/H3N2/67/2005) enrolled in a study of influenza transmission. Exhaled breath samples from both groups were collected using the G-II bioaerosol sampler following identical sampling protocols. CAI samples were subtyped using CDC’s panel and all were quantified alongside EI samples in the same lab by RTqPCR using CDC Taqman® primers and probes for influenza A virus.
Findings:
We collected breath samples from 86 CAI cases with confirmed H3N2 infection and 52 EI cases. We detected influenza virus in coarse aerosol from 12% coarse (GM=42, GSD=2.2, range 30 - 1.8*102) of the EI cases and 56% (GM=2.5*102, GSD=15, range from 7.8 -2.3*106) of the CAI cases. We detected influenza virus in fine aerosol from 20 % (GM=76, GSD=2.9, range 23-5.2*102) of the EI cases and 86% (GM=7.4*102, GSD=13, range 18-3.0*105) of the CAI cases.
The frequency and intensity of shedding was much lower from EI cases than CAI cases. Experimentally infected donors may have had immunity not detected by serology or the partially attenuated laboratory virus may not have been capable of inducing significant shedding. However, based on historical data, the most likely explanation is that nasal inoculation produced mild infection with minimal shedding. Nasal inoculation EI does not appear to produce an adequate model for clinical trials to study infection transmission.

Abstract: This report describes a study of the characterization of respiratory droplets collected from infected individuals.
We screened volunteers for the influenza infection and recruited persons meeting the following criteria: either a positive rapid test, or fever 37.8°C plus cough or sore throat, and were screened within the first three days of onset of symptoms. We collected exhaled breath samples, using the G-II bioaerosols sampler, nasopharyngeal (NP) swabs, and questionnaires from each subject. Each NP swab and fine (<5μm) aerosol sample were assayed by culture passage and fluorescent focus assay on MDCK cells. All samples were quantified by RTqPCR.
Of the 178 person-illnesses studied, 86 were H3N2, 3 pdmH1, 64 influenza B, and 5 were culture positive but negative for influenza by PCR and focus assay, 1 unsubtypable influenza A, 3 dual infection (H3 & pdmH1, H3 & B, pdmH1 &B), 16 negative for laboratory evidence of infection (total of 157 person-illness episodes of proven influenza infection). We obtained valid culture results (passage and/or focus assay) from 228 NP swabs and 215 fine aerosol samples including all subjects; 82% of NP swabs and 46% of fine aerosol samples were positive for influenza.
We detected influenza virus by RTqPCR in 46% of the coarse and 66% of fine aerosol fraction samples including all subjects. The geometric mean number of viral RNA copies in coarse (3.8, 95%CI 0.5-29) and fine (44, 95%CI 17-109).
We observed weak correlations of cough with PCR detected virus particle numbers in fine (r=0.4, p<0.05) and coarse (r=0.3, p<0.05) aerosols. Our finding of culturable virus in a large proportion of aerosol samples demonstrates that influenza patients shed not merely RNA but infectious virus into airborne droplets, contributing to literature that airborne transmission via fine aerosols is biologically plausible and is likely a major route of transmission of influenza virus.

Presenter: Robert Feldman
(School of Public Health (UMD) Behavioral and Community Health Faculty)

Author(s):

Feldman, Robert (UMD SPH Behavioral and Community Health)

Lipscomb, Jane (UMB SON Centera for Community-based Engagement)

Barrows, Beth (UMB SON)

Louis, J. Fredo (UMD SPH Behavioral and Community Health)

Abstract: Background and Objectives: According to WHO, about three million of the world’s 35 million healthcare workers are occupationally exposed to Blood Borne Pathogens (BBP) each year. More than 90% of all occupational exposures occur in developing countries where the prevalence of three most common blood-borne pathogens (hepatitis B, C, and HlV) may be higher than that of developed countries. In Haiti, the HIV and hepatitis prevalence is about 2-4%. Therefore, in order to address BBP exposure among healthcare workers in Haiti a team of investigators from public health, nursing and medicine in the US and Haiti conducted a pilot study to assess practices to prevent BBP transmission in hospitals in Haiti. Methods: Surveys in Haitian Creole were administered to 97 hospital employees (nurses, physicians, housekeeping staff, and lab technicians) assessing previous occupational exposure and workplace practices related to BBP. Additional questions asked about Ebola preparedness and handling of medical waste. Results and Conclusions: The one-year prevalence of blood-borne pathogen exposure in our study of Haitian hospitals was 16.6 per 100 FTE. This was higher than the rate found among Maryland nurses that was 12.6 per 100 FTE. Also, we found that physicians reported substantially greater injuries due to being stuck with a needle or other sharp object contaminated with blood or bodily fluids while at work (50.00%) compared with nurses (27.45%), housekeepers (26.32%), and lab technicians (15.38%). In addition, physicians were injured in the past year at a greater rate, and reported their injury or exposure less than other professions. These findings indicate the need for a greater focus on educating and training physicians on occupational safety and health in Haitian hospitals.

Abstract: Background: The workplace is an ideal site for physical activity promotion initiatives because adults spend a significant portion of their waking hours at the workplace. Healthiest Maryland Businesses (HMB) was launched in 2010 as a statewide movement focused on creating a culture of wellness through policy, systems, and environmental change.
Objectives: The purpose of this study is to describe physical activity best practices among Maryland businesses, and identify correlates of engaging in best practices among businesses enrolled in the HMB initiative.
Methods: Beginning in 2014, enrolled businesses completed the Centers for Disease Control and Prevention’s (CDC’s) Worksite Health ScoreCard (HSC), which includes 16 topics and 122 items on best practices in Worksite Health Promotion and business demographics. Analyses of the HSC data included descriptive statistics, correlations, and ANOVA (with post-hoc analysis).
Results: From April 2014 to July 2015, 149 businesses enrolled in HMB. At baseline, more than half of businesses provided environmental supports for physical activity, organized physical activity programs for employees, and provided information/education on the benefits of physical activity, with few businesses using physical activity promotion signage and offering opportunities for physical fitness assessments. Maryland businesses received an overall lower physical activity score compared to the CDC’s comparison sample (maximum possible=23, CDC sample=13, Maryland=11). Nonprofit/other businesses had the highest physical activity score (15.13), followed by nonprofit/government (10.46), then for-profit (9.26, F=3.853, p=0.023). As workplace size increased, so did physical activity score (very small (<100)=7.56; small (100-249)=10.56; medium (250-749); and large (750+); F=11.036, p=<0.001).
Conclusions: Maryland businesses are providing physical activity resources to employees, but there is still room for improvement. Future research and efforts should focus on supporting small businesses in creating opportunities to improve physical activity behaviors among employees.

Abstract: Objective: To describe PA engagement, knowledge, social support, motivators, and barriers of LTC staff.
Background: LTC staff demonstrate higher cardiovascular disease risk, healthcare service utilization rates, and healthcare costs compared to other industries. Physical inactivity is a major risk factor for CVD and only about half of healthcare workers report meeting PA recommendations.
Methods: Baseline data from a PA, diet, and stress management focused worksite health promotion program study was used to describe the PA knowledge, social support, motivators, and barriers of staff in LTC settings via questionnaire. Objective pedometer and subjective questionnaire data from 98 LTC staff was used to describe their PA.
Results: Participants self-reported ¯x 25.67 hours (SD=1814.67) per week of PA. Pedometer data revealed that 89.3% of respondents did not engage in any weekly aerobic activity with a median of 0 weekly aerobic minutes (SD=18.50). 73 (97%) participants could not articulate PA guidelines. The strongest PA motivators were: (1) positive health ¯x 4.38 (SD=3.07), (2) ill-health avoidance ¯x 4.26 (SD=3.27), (3) strength/endurance ¯x 4.06 (SD=3.98), and (4) weight management ¯x 4.04 (SD=4.82). The most common barriers related to working in LTC were: (1) exhaustion (59.4%), (2) work hours (28.1%), (3) lack of time (15.6%), and (4) perception of a physically active job (9.4%). Survey data found participants to have low perceived social support for healthy behaviors from their boss ¯x 3.0 (SD=3.39) and coworkers ¯x 4.02 (SD=3.97). This is considerably lower than from friends ¯x 6.23 (SD=4.35) and family ¯x 7.13 (SD=5.19).
Conclusions: The data suggests that LTC staff overestimate their PA. This may be related to a lack of understanding about PA and workplace-related barriers. Thus, there is a need to provide LTC staff with PA education and opportunities to be active at work that emphasizes their PA motivation while reducing their barriers.